The "donut" mastopexy: indications and complications

A previously described technique of mastopexy is employed whereby a donut-shaped portion of periareolar skin is deepithelized. The radius of the skin to be removed is usually 2 to 3 cm and includes a portion of the areola. The resulting wound is closed, leaving only a periareolar scar. The primary motivation for such a mastopexy was (1) minimizing scar to the periareolar area, (2) complete preservation of nipple sensation, and (3) ease and short duration of surgery. It is often used to correct a protuberant nipple-areolar complex ("Snoopy" deformity). Follow-up on 13 patients who underwent the procedure for ptosis indicated that surgery is brief and easy to perform, and nipple sensation is preserved. However, ptosis may recur even in small breasts; the periareolar scar often becomes hypertrophic; the breasts assume a more globular shape; and areolar spreading occurs to some extent in most cases. In view of the potential problems with the donut mastopexy it is suggested that (1) the procedure be reserved for very small breasts or those with only a protuberant nipple-areolar complex, where there is little weight to hasten areolar stretching and recurrent ptosis, and (2) the new areolar should be made smaller than desired in anticipation of post-operative stretching.